Central pillar of the NHS comes under pressure

Anyone who has ever had to wait more than a week for an appointment with their GP will know that many local surgeries are under pressure but the scale of that pressure, and whether enough is being done by ministers to alleviate it, is becoming one of the central issues of the National Health Service in Scotland.

Anyone who has ever had to wait more than a week for an appointment with their GP will know that many local surgeries are under pressure but the scale of that pressure, and whether enough is being done by ministers to alleviate it, is becoming one of the central issues of the National Health Service in Scotland.

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Herald View

The most recent figures show funding for primary medical services including GPs was £756 million in 2012-13, compared to £747m the year before and £519m 10 years ago. But, as part of a new campaign on funding, the Royal College of General Practitioners claims these figures do not reveal the full picture. Not only has funding for GPs fallen in real terms in recent years, it says, it has also failed to keep pace with the total NHS budget. A decade ago, it was more than nine per cent total NHS; today it is 7.5 per cent. What makes this change particularly important is that the fall in the proportion of NHS money spent on GPs is happening at precisely the time when the workload in surgeries is rising and is likely to further increase in the years to come. The Scottish Government's strategy for the NHS is to shift more of the burden of care for the elderly out of hospitals and into the community and it is inevitable that some of this burden will fall on GPs. There is also a rising demand on GP services generally because of Scotland's ageing population.

The Royal College of General Practitioners says all of this has left GPs struggling to cope and that the lack of proper funding means many doctors are regularly working 11-hour days, seeing up to 60 patients in that time. To make matters worse, there is also a recruitment crisis in the service with many GP posts across Scotland left unfilled.

Inevitably, there will be some who struggle to have sympathy with the doctors' complaints because of the generous pay deal they were awarded 10 years ago. Not only has that deal led to the average GP earning nearly £90,000 a year (topped up by small annual increases), local surgeries still do not have any responsibility to provide out-of-hours cover. Some patients might think all of this means GPs are not the worst-hit of Scotland's public sector workers.

While there is some truth in that, it would be wrong to dismiss the GPs as well-paid whingers. They are right to point out that they deal with the vast majority of patients seen by the NHS and they are also right to be concerned that the shift towards care closer to home will increase the pressure on what is one of the central pillars of the health service.

The shift in care away from hospitals may be the right strategy but, as The Herald has pointed out as part of our NHS: Time for Action campaign, such a shift requires a review of the distribution of resources and funding.

An effective, efficient GP surgery can prevent patients ending up in hospital and keep them healthier for longer but only a review of resources and staff in hospitals and the community can establish if doctors have the resources they need to do that job. The case for such a review is stronger than ever.

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